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Jennings AL et al A systematic review of the use of opioids in the management of dyspnea Thorax 2002 Nov;57(11):939 44 [PMID: 12403875] Karnani NG et al Evaluation of chronic dyspnea Am Fam Physician 2005 Apr 15;71(8):1529 37 [PMID: 15864893] Luce JM et al Management of dyspnea in patients with faradvanced lung disease: once I lose it, it s kind of hard to catch it JAMA 2001 Mar 14;285(10):1331 7 [PMID: 11255389] Mahler DA et al Evaluation of dyspnea in the elderly Clin Geriatr Med 2003 Feb;19(1):19 33 [PMID: 12735113] Straus SE et al The accuracy of patient history, wheezing, and laryngeal measurements in diagnosing obstructive airway disease CARE-COAD1 Group Clinical Assessment of the Reliability of the Examination-Chronic Obstructive Airways Disease JAMA 2000 Apr 12;283(14):1853 7 [PMID: 10770147]

Clinicians are able to identify airflow obstruction on examination, but they have limited ability to assess it or to predict whether it is reversible The evaluation for asthma should therefore include spirometry (FEV1, FVC, FEV1/FVC) before and after the administration of a short-acting bronchodilator These measurements help determine the presence and extent of airflow obstruction and whether it is immediately reversible Airflow obstruction is indicated by a reduced FEV1/FVC ratio (< 70%) In severe airflow obstruction with significant air trapping, the FVC may also be reduced, resulting in a pattern that suggests a restrictive ventilatory defect Significant

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Symptoms Mild intermittent Symptoms 2 times a week Asymptomatic and normal PEF between exacerbations Exacerbations brief (few hours to few days); intensity may vary Symptoms > 2 times a week but < 1 time a day Exacerbations may affect activity Daily symptoms Daily use of inhaled short-acting 2-agonist Exacerbations affect activity Exacerbations 2 times a week; may last days Continual symptoms Limited physical activity Frequent exacerbations Nighttime Symptoms 2 times a month Lung Function FEV1 or PEF 80% predicted PEF variability 20%

Example 15-1 begins by declaring two strings, s1 and s2, and initializing them with string literals:

FEV1 or PEF > 80% predicted PEF variability 20 30% FEV1 or PEF > 60% to < 80% predicted PEF variability > 30%

FEV1 or PEF 60% predicted PEF variability > 30%

Adapted from National Asthma Education and Prevention Program Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma National Institutes of Health Pub No 97-4051 Bethesda, MD, 1997 PEF, peak expiratory flow; FEV1, forced expiratory volume in the first second

string s1 = "abcd"; string s2 = "ABCD";

Mild Symptoms Breathlessness Speech Signs Body position Respiratory rate Use of accessory respiratory muscles Breath sounds Able to recline Increased Usually not Moderate wheezing at mid- to end-expiration < 100 < 10 May be agitated > 80 Prefers sitting Increased Commonly Loud wheezes throughout expiration 100 120 10 25 Usually agitated 50 80 Unable to recline Often > 30/min Usually Loud inspiratory and expiratory wheezes > 120 Often > 25 Usually agitated < 50 or response to therapy lasts < 2 hours < 91 < 60 42 Unable to recline > 30/min Paradoxical thoracoabdominal movement Little air movement without wheezes Relative bradycardia Often absent Confused or drowsy < 50 With activity Sentences With talking Phrases At rest Words At rest Mute Moderate Severe Impending Respiratory Failure

Heart rate (beats/min) Pulsus paradoxus (mm Hg) Mental status Functional assessment PEF (% predicted or personal best) SaO2 (%, room air) PaO2 (mm Hg, room air) PacO2 (mm Hg)

Adapted from National Asthma Education and Prevention Program Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma National Institutes of Health Pub No 97-4051 Bethesda, MD, 1997 PEF, peak expiratory flow

Developers B and C perform an update to get the new changes. Developer B adds some functions to io.c and io.h, and goes home for the night. That night, developers A and C need a common I/O function to continue with their work. Developer C performs an update, getting the latest version of io.c and io.h, adds the function, and commits the files so developer A can use the new function. Developer A performs an update, getting the latest version of the files that include the new function. Developer B is at home, completely unaware of the new additions. After returning, developer B performs an update, and CVS merges any new changes into the working version of io.c and io.h. If there are any conflicts, CVS alerts developer B, and changes are manually fixed.

Compare( ) is used with many types. A negative return value indicates that the first parameter is less than the second; a positive result indicates that the first parameter is greater than the second; and a zero indicates that they are equal. In Unicode (as in ASCII), a lowercase letter has a smaller value than an uppercase letter; with strings that are identical except for case, lowercase comes first alphabetically. Thus, the output properly indicates that s1 (abcd) is less than s2 (ABCD):

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